Let’s leave Sue for a short time and talk about some of the issues surrounding depression. Some of the effects of depression on individuals are:

1) Too little or too much sleep

2) Death wishing (trying to get away from the suffering) and thoughts of suicide

3) Loss of interest in things that use to be pleasurable

4) Difficulty in concentrating

5) Change in eating habits

6) Sadness

7) A negative view of the past, present and future

8) A feeling of helplessness and/or hopelessness

9) Bouts of crying

10) Obsessional worries, acts, ruminations, or images

11) Difficulty making decisions

12) Feelings of guilt and unworthiness

13) Lack of energy

Depression can be caused by genetic factors (passed down from generation to generation), the difficult situations we are faced with in life, or a combination of the two. A minority of depressions are caused by genetic factors. The majority of depression is caused by our reaction (reactive depression) to life situations that we have to deal with. The depression that is caused by the situations we face in life may also have a genetic element but this element is usually small.

Those people who are experiencing primarily a reactive depression many times do not recognize or acknowledge the effects of depression until the depression is serious. If you, or someone you know, exhibit the above characteristics, contact your doctor or a counselor in your area.

Some people describe being depressed as looking through a tinted window. They see things more negatively than they really are. The depressed individual sees almost everything in a negative light. People around this individual notice this and try to get them to see things as they really are but find that it is easier said than done. If the depressed person can see life in a more realistic light, they will probably begin to come out of the depression.

Much of depression is related to one’s beliefs. These beliefs may have been formulated many years ago and are therefore quite enduring. To tell a depressed person to just simply to snap out of it or to look at things more realistically does not help. In fact, these types of statements just make the depressed person more depressed. It is important to be sensitive with people who are going through depression.

It is evident to those around a depressed person that they are looking at things in an excessively negative manner. Since they really believe their interpretations, it is important to be sensitive in offering any advice. Being too forceful with one’s opinions can cause more damage than good. Be gentle with a depressed person while kindly and sensitively pointing out more realistic alternatives.

What effect does medication have on depression? When we look at the physical effects of depression we must start with the way messages travel through the nerve cells in the brain. Impulses travel through our brain nerve cells electrically. Nerve cells are surrounded by a solution that keeps the cells from touching. The impulses traveling through the cells must somehow get across this solution to the next cell. The impulses are carried over on neurotransmitters. There are primarily three main neurotransmitters that we are concerned about when treating depression:

1) Dopamine

2) Norepinephrine

3) Serotonin

When people are experiencing depression, at least one of these neurotransmitters is in short supply at the gap between the nerve cells (usually Serotonin or maybe Norepinephrine). One way to increase the number of neurotransmitters at this gap [called the synaptic gap] is to take medication that helps keep selected neurotransmitters concentrated in the gap where they can help ferry the nerve messages across.

Tricyclic antidepressants (named for their chemical structure) were at one time the most commonly used medications for treatment of major depressions. They have been replaced in many cases by SSRIs (selective serotonin reuptake inhibitors) which work primarily on Serotonin. There are now some newer antidepressants that work on both serotonin and norepinephrine.

Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. One advantage of Wellbutrin is that it has not been associated with weight gain or sexual dysfunction.

The good news is that depression is treatable. Many times a combination of counseling and medication is an effective mix. In the next issue of our newsletter, we will again analyze some of Sue’s beliefs and perceptions to see how realistic they are and what can be changed to make them more so.